Karachalios Theofilos, Zibis Aristides H, Zintzaras Elias, Bargiotas Konstantinos, Karantanas Apostolos H, Malizos Konstantinos N
Department of Orthopedics, School of Health Sciences, University of Thessalia, Larissa, Hellenic Republic. kar@ med.uth.gr
Orthopedics. 2010 Oct 11;33(10):733. doi: 10.3928/01477447-20100826-12.
Although percutaneous fixation with iliosacral screws has been shown to be a safe and reproducible method for sacroiliac dislocation and sacral fractures, it is a technically demanding technique, and one of its contraindications is sacral anatomical variations and dysmorphism. The incidence and pattern of S1 and S2 anatomical variations were evaluated in 61 patients (35 women and 26 men) using magnetic resonance imaging of the sacrum in an attempt to explore the possible existence of groups of individuals in whom percutaneous sacroiliac fixation is difficult due to local anatomy. S1 and S2 dimensions in both the transverse and coronal planes were recorded and evaluated. In each individual, S1 and S2 dimensions both in the coronal and transverse planes were proportional, with S2 dimensions being 80% of those of S1 on average. Patients were separated into 4 groups based on the S1 and S2 body size and the asymmetry of dimensions in the transverse and coronal planes. In 48 patients (78.6%), dimensions in both planes were symmetrical despite the varying size of the S1 and S2 body. In 2 patients (3.3%) there was a combination of large transverse plane and small coronal plane dimensions, with large S1 and S2 body size. In 9 patients (14.8%), coronal plane dimensions were disproportionately smaller compared to those of the transverse plane, with a varying size of S1 and S2 body making effective sacroiliac screw insertion a difficult task. Thus, a preoperative imaging study, preferably computed tomography scan, of S1 and S2 body size and coronal plane dimensions and an intraoperative fluoroscopic control of S1 and S2 dimensions on the coronal plane are suggested for safe sacroiliac screw fixation.
尽管经皮置入髂骶螺钉已被证明是治疗骶髂关节脱位和骶骨骨折的一种安全且可重复的方法，但它是一项技术要求较高的技术，其禁忌证之一是骶骨解剖变异和畸形。本研究对61例患者（35例女性和26例男性）进行骶骨磁共振成像，评估S1和S2解剖变异的发生率和模式，以探索是否存在因局部解剖结构导致经皮骶髂固定困难的个体群体。记录并评估S1和S2在横断和冠状面上的尺寸。在每个个体中，S1和S2在冠状面和横断面上的尺寸都是成比例的，S2尺寸平均为S1的80%。根据S1和S2的身体大小以及横断和冠状面上尺寸的不对称性，将患者分为4组。48例患者（78.6%）中，尽管S1和S2身体大小不同，但两个平面的尺寸是对称的。2例患者（3.3%）横断平面尺寸大而冠状平面尺寸小，S1和S2身体较大。9例患者（14.8%）冠状面尺寸与横断平面相比不成比例地小，S1和S2身体大小各异，使得骶髂螺钉的有效置入成为一项困难的任务。因此，建议术前进行S1和S2身体大小及冠状面尺寸的影像学检查，最好是计算机断层扫描，并在术中通过荧光透视控制冠状面上的S1和S2尺寸，以确保骶髂螺钉固定的安全。
